Journal
KIDNEY INTERNATIONAL
Volume 99, Issue 6, Pages 1280-1295Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.kint.2021.03.020
Keywords
anemia; chronic kidney disease; dialysis; erythropoiesis stimulating agents; erythropoietin; hepcidin; hypoxia-inducible factor-prolyl hydroxylase inhibitor; iron; iron deficiency
Categories
Funding
- KDIGO
- Akebia Therapeutics
- AMAG Pharmaceuticals
- Amgen
- Astellas
- AstraZeneca
- Boehringer Ingelheim
- FibroGen
- GlaxoSmithKline
- Mitsubishi Tanabe Pharma Group
- Pharmacosmos
- Roche
- Rockwell Medical
- Torii Pharmaceutical
- Vifor Fresenius Medical Care Renal Pharma
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Chronic kidney disease is often associated with anemia and disordered iron homeostasis, which have significant adverse consequences. In 2012, KDIGO issued guidelines for managing anemia in chronic kidney disease, and in 2019, they convened conferences to review new evidence and controversies related to iron and anemia treatment. The first conference focused on iron-related issues like diagnostic challenges, treatment options and patient outcomes.
In chronic kidney disease, anemia and disordered iron homeostasis are prevalent and associated with significant adverse consequences. In 2012, Kidney Disease: Improving Global Outcomes (KDIGO) issued an anemia guideline for managing the diagnosis, evaluation, and treatment of anemia in chronic kidney disease. Since then, new data have accrued from basic research, epidemiological studies, and randomized trials that warrant a re-examination of previous recommendations. Therefore, in 2019, KDIGO decided to convene 2 Controversies Conferences to review the latest evidence, explore new and ongoing controversies, assess change implications for the current KDIGO anemia guideline, and propose a research agenda. The first conference, described here, focused mainly on iron-related issues, including the contribution of disordered iron homeostasis to the anemia of chronic kidney disease, diagnostic challenges, available and emerging iron therapies, treatment targets, and patient outcomes. The second conference will discuss issues more specifically related to erythropoiesis-stimulating agents, including epoetins, and hypoxia-inducible factor-prolyl hydroxylase inhibitors. Here we provide a concise overview of the consensus points and controversies resulting from the first conference and prioritize key questions that need to be answered by future research.
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